OP&F News

Which plans are eligible for the OP&F stipend?

As open enrollment for health care is upon us, OP&F would like to remind retirees that not all plans are eligible for the health care stipend.

For retirees who are not yet eligible for Medicare, a major tenant of OP&F’s program and eligibility criteria is that members must enroll in a major medical qualified health plan that conforms to the regulations set forth in the Affordable Care Act (ACA). OP&F opened the Health Reimbursement Arrangement (HRA) in 2020 so that pre-Medicare individuals could purchase COBRA plans or plans on or off the eHealth exchange. However, the program and eligibility criteria still required medical policies to be ACA compliant insurance plans. Specifically, members who enroll in short term plans, cost sharing plans and Christian-based plans are ineligible to receive the stipend.

The Internal Revenue Service has a specific list of guidelines that describes reimbursable expenses that are allowed under the OP&F Health Reimbursement Arrangement. Cost-sharing plans and Christian-based plans that charge membership fees are not considered health insurance premiums under the IRS guidelines and therefore are not reimbursable expenses through the HRA.

Retirees who are 65 years of age or older must be enrolled in Medicare Part A and Part B. If OP&F determines that you are eligible to receive the stipend, you must enroll in a health care plan and/or prescription drug plan through Alight.

Please refer to the retiree health care page on the OP&F website for additional information.

(ALSO: Members who intend to use their employer’s COBRA benefit at retirement must have all their paperwork to OP&F within 60 days of when they are no longer covered by their employer’s plan).

Posted 10/28/2022

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